Provider Demographics
NPI:1598727083
Name:DAUGHERTY, JAMES PATRICK (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:256-705-4224
Mailing Address - Fax:256-705-4135
Practice Address - Street 1:1751 VETERANS DR STE 190
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4930
Practice Address - Country:US
Practice Address - Phone:256-760-0422
Practice Address - Fax:256-284-6065
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10732207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL110019337Medicare PIN
ALC34102Medicare UPIN
AL000086470Medicare ID - Type Unspecified
000076508Medicare ID - Type Unspecified